Abstract
The complications and costs of chronic dialysis in 4 patients with renal failure due to multiple myeloma are presented. In three patients the paraprotein responded to chemotherapy though without recovery of renal function. These three patients are alive after 18, 16 and 15 months of dialysis, the other dying after 7 months. Hospital admissions ranged from 26 to 74 days per year with infections accounting for 54 to 87% of admission days, 62.5% of which occurred during the first three months of dialysis treatment, with an incidence of 2.4 to 6.9 admissions episodes per year. An in-house audit of our chronic dialysis patients indicated that treatment of myeloma patients is 5-33% more expensive. The extra cost in such high risk patients is mostly due to the greater number and longer duration of hospital admissions for infection. The other extra costs (in decreasing value) of blood products, antibiotics and chemotherapy are relatively small in comparison to in-patient treatment.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Barlogie B., Smith L., Alexanian R. Effective treatment of advanced multiple myeloma refractory to alkylating agents. N Engl J Med. 1984 May 24;310(21):1353–1356. doi: 10.1056/NEJM198405243102104. [DOI] [PubMed] [Google Scholar]
- Cohen H. J., Rundles R. W. Managing the complications of plasma cell myeloma. Arch Intern Med. 1975 Jan;135(1):177–184. [PubMed] [Google Scholar]
- Cosio F. G., Pence T. V., Shapiro F. L., Kjellstrand C. M. Severe renal failure in multiple myeloma. Clin Nephrol. 1981 Apr;15(4):206–210. [PubMed] [Google Scholar]
- Coward R. A., Mallick N. P., Delamore I. W. Should patients with renal failure associated with myeloma be dialysed? Br Med J (Clin Res Ed) 1983 Nov 26;287(6405):1575–1578. doi: 10.1136/bmj.287.6405.1575. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Durie B. G., Salmon S. E. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer. 1975 Sep;36(3):842–854. doi: 10.1002/1097-0142(197509)36:3<842::aid-cncr2820360303>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
- FAHEY J. L., SCOGGINS R., UTZ J. P., SZWED C. F. INFECTION, ANTIBODY RESPONSE AND GAMMA GLOBULIN COMPONENTS IN MULTIPLE MYELOMA AND MACROGLOBULINEMIA. Am J Med. 1963 Nov;35:698–707. doi: 10.1016/0002-9343(63)90140-2. [DOI] [PubMed] [Google Scholar]
- Gokal R., Baillod R., Bogle S., Hunt L., Jakubowski C., Marsh F., Ogg C., Oliver D., Ward M., Wilkinson R. Multi-centre study on outcome of treatment in patients on continuous ambulatory peritoneal dialysis and haemodialysis. Nephrol Dial Transplant. 1987;2(3):172–178. [PubMed] [Google Scholar]
- Jacobson D. R., Zolla-Pazner S. Immunosuppression and infection in multiple myeloma. Semin Oncol. 1986 Sep;13(3):282–290. [PubMed] [Google Scholar]
- Johnson W. J., Kyle R. A., Dahlberg P. J. Dialysis in the treatment of multiple myeloma. Mayo Clin Proc. 1980 Feb;55(2):65–72. [PubMed] [Google Scholar]
- Kyle R. A. Multiple myeloma: review of 869 cases. Mayo Clin Proc. 1975 Jan;50(1):29–40. [PubMed] [Google Scholar]
- Manis T., Friedman E. A. Dialytic therapy for irreversible uremia (first of two parts). N Engl J Med. 1979 Dec 6;301(23):1260–1265. doi: 10.1056/NEJM197912063012304. [DOI] [PubMed] [Google Scholar]
- Perri R. T., Hebbel R. P., Oken M. M. Influence of treatment and response status on infection risk in multiple myeloma. Am J Med. 1981 Dec;71(6):935–940. doi: 10.1016/0002-9343(81)90303-x. [DOI] [PubMed] [Google Scholar]
- Rota S., Mougenot B., Baudouin B., De Meyer-Brasseur M., Lemaitre V., Michel C., Mignon F., Rondeau E., Vanhille P., Verroust P. Multiple myeloma and severe renal failure: a clinicopathologic study of outcome and prognosis in 34 patients. Medicine (Baltimore) 1987 Mar;66(2):126–137. doi: 10.1097/00005792-198703000-00004. [DOI] [PubMed] [Google Scholar]
- Twomey J. J. Infections complicating multiple myeloma and chronic lymphocytic leukemia. Arch Intern Med. 1973 Oct;132(4):562–565. [PubMed] [Google Scholar]
- WRIGHT E. T., WINER L. H. Herpes zoster and malignancy. Arch Dermatol. 1961 Aug;84:242–244. doi: 10.1001/archderm.1961.01580140068007. [DOI] [PubMed] [Google Scholar]
- Williams A. Economics of coronary artery bypass grafting. Br Med J (Clin Res Ed) 1985 Aug 3;291(6491):326–329. doi: 10.1136/bmj.291.6491.326. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wood I. T., Mallick N. P., Wing A. J. Prediction of resources needed to achieve the national target for treatment of renal failure. Br Med J (Clin Res Ed) 1987 Jun 6;294(6585):1467–1470. doi: 10.1136/bmj.294.6585.1467. [DOI] [PMC free article] [PubMed] [Google Scholar]